Monday, February 28, 2011

27 weeks — shiningly glorious old stretch marks on the outside, baby of who knows what size on the inside

Sorry to harp on this, but it keeps coming up. My midwife made a big deal again about how I need to "watch that weight gain" and cut out all white flour and sugar from my diet. She acknowledges that some big babies are genetic (um, yeah, I know), but then she had to go and play the Dead Baby card. I hate it when people do that.

She told me about a client of hers who was borderline for gestational diabetes and "cheated" the test by having her OB (I take it she was under some form of coordinated care) coach her on how to avoid testing positive. Once she squeaked through, she, in the words of my midwife, "totally let herself go" and packed on the pounds that last trimester. During labor, the woman admitted she had been baking for herself every day and eating pies, cakes, cookies, and so forth. (The horror!)

She was a small woman, and her 12-pound baby was lodged with an extreme shoulder dystocia that took the midwife seven minutes of hard work to dislodge. The baby was floppy and unresponsive and had to be rushed in an ambulance to the ER, EMTs fighting to resuscitate him.
My midwife was mad at her client, that she had risked her baby's life for the sake of some sweets — not to mention the midwife's practice.

The implication was clear. Either I followed the no-white-flour-and-no-sugar edict, or I would be the one risking the Dead Baby.

Let two things be known:

I don't take that woman's story lightly. I think that's a horrible situation for all of the participants to have been in. It's possible she had a hand in it for baking too much; I couldn't say because I'm getting only one perspective on the tale.

I don't appreciate scare tactics.

As my midwife fully admitted, I had a nearly 12-pound baby, with no dystocia, a mere hour and a half of pushing, a vaginal birth with minimal tearing, a pregnancy free of GD, a baby with no blood sugar problems, and a healthy outcome for all involved.

So is the fear that I'll somehow go for a world's record here and try to beat my previous baby's weight? Because, trust me, I won't mind having a smaller one this time around and expect that as the statistical probability.

There are several things niggling at me from her edict. I'm not even sure how to sort them all out, in my mind or in this post.

She's assuming that limiting maternal weight gain will ensure that the baby's weight gain is also limited. This is not so clearcut.

She's assuming that limiting the baby's weight gain is preferable to allowing a baby to grow to whatever size it chooses. This seems dangerous to me.

She admits that Sam and I are large people (tall and broad, and I have a wide pelvis), that I come from a family of occasionally very large babies, that I previously had a large baby with no ill effects on either of us. And yet she continues the scare stories.

She emphasizes staying active over specific numbers of pounds, which is good. But she discounts how much pain I'm in from this pregnancy in my pelvis and hips, and how challenging it is to exercise daily when it hurts to walk. (I do keep trying to push through.)

All of my tests so far — blood, urine, blood pressure, fundal measurements — have been fine. I'm scheduled for a GD test this week, so we'll see. (Anyone have arguments for or against having the test? I'm still a little conflicted.)

I gained 33 pounds last pregnancy and lost it within two weeks postpartum. I don't say that to brag or as an indicator of what I consider normal (I was actually very, very surprised when that happened), and I worry it sounds that way. I say it more as a justification that my body knew exactly how much weight it needed to support the pregnancy, even though I had an unusually big baby. I've already gained that much this time around, and I haven't gone through the third trimester yet, so she might have a point there. Or not. I'm not sure. I definitely am not expecting to lose it all as quickly postpartum this time. (I mean, I have no expectations either way, not that I expect not to lose it; either way is fine)

She's assuming that white flour and sugar are "bad" foods. I have issues with this that I don't even know how to go into here, in a short time. I find it problematic to demonize foods and assume that because they don't fit our current vision of what righteous food looks like that they have no value, or indeed a wholly negative effect.

Even if I agree with her that white flour and sugar are to be avoided, she's assuming that I can. I know very few people who, long-term (5 years or more), have cut out easily available, tasty food groups from their diet. The few I do know have a medically unpleasant reaction to such foods and therefore a big incentive not to cheat. Now, my timeframe is a mere three months. But, I know myself. I know that when I'm told I am not allowed to have something, that is all I want. When allowed to eat as I wish, I tend to eat a variety of foods and not stuff myself. Even pregnant and more sharply hungry, I don't believe I've been eating more than usual — just more immediately when hungry, but then I feel full sooner. When told I must eat a certain Right way, I tend to rebel. Oh, I know, the Dead Baby card is supposed to keep me in line. But I'm finding it hard to buy in. I've already found my sneaky diet-mind telling me things like, "She didn't say anything about white corn and white rice. Score!"

Several years ago, Sam and I did the South Beach Diet, which is my best personal reference for a practice of cutting out white carbs and sugar. We lost about 40 pounds on this diet and were hungry much of the time (and, incidentally, found it challenging to eat hospitably with others, such as at friends' houses or restaurants). I have some reservations about adopting any sort of eating plan that would normally prompt weight loss, considering I'm pregnant and losing weight can be detrimental to the baby's health.

I'm seriously feeling I'd like to switch midwives. But without the psychological effort involved in switching midwives. I put off choosing one for so long precisely because I was having trouble screwing up the gumption to interview some; in the end, I interviewed exactly this one, and liked her a lot the first time we met. So I'd actually need to visit some other midwife/midwives multiple times, to make sure I liked them better, before firing this one. And the firing part would totally bum me out. Plus, I like her attitude toward low interventions in birth, and that's ultimately more important to me than sparkly-rosy-happy prenatal visits. Though those would be nice, too. I wish the midwives I had last time were still practicing, but they're on an extended hiatus.

I was prepared to ignore the recommendations and try to put it out of my mind. Sam, though, took it on himself (he's our cook) to consider ways we can reimagine meals we like in non-white-flour ways as well as create a list of meals that need no rejiggering to fit the criteria (like one of our favorites: currywurst with mashed cauliflower). He also suggested we cut down on the junk purchases. On the same day he brought home Girl Scout cookies. Bless him.

I know one thing for sure: I would have no luck cutting out white flour without him, so I'm glad he's willing to go through the deprivation with me. He keeps reminding me it's only three months, so maybe we'll make it.

If a provider doesn't take my morals, beliefs, and thoughts into account - and I believe their prescribed treatment may be hurting me or my loved ones - I find a new one. Fortunately I often can; many others are not so fortunate.

Even before I got to the point in this post where you admitted thinking about other providers, I was going to comment that it sounds like you need a new midwife! I can definitely appreciate how difficult that can be, though.

Have you let her know how uncomfortable you are with 1)her overzealous attention to weight gain and 2)scare tactics? I'm not a huge fan of confrontation, but it might end up being less work than a whole new midwife. Like you, I think that as long as your overall diet is healthy and within reason, you don't need to completely eliminate anything, or stare at a scale everyday. I think your first pregnancy is pretty good proof that your body knows what it's doing.

Perhaps keeping a food diary for a few days and showing this to the midwife, to demonstrate the quality (and quantity) of your nutrition, would help drive the point home. Passing the GD test would be another bee in your bonnet, for sure.

My thought is just to trust your gut (pun totally intended!). You seem very knowledgeable about your health as well as your baby's genetic history, and I bet that deep down inside you know what is right for you and your baby.

You also have the right to tell your midwife, 'Thank you for your concern, but I'm not interested in talking about my weight anymore, unless I decide to initiate a conversation about it later' and see what she says. If she respects that, I think she is a keeper. If not, it might be a time to start those dreaded interviews.

I am curious about what other posters think about the GD test. I'm 17 weeks preg with my first and haven't decided if I will take this myself. Part of me is anti-testing and intervention, but the other part of me knows that if I'm positive, I have the power to actually change it (as opposed to other concerns brought up by pre-natal tests.) Hmmm...

I recently had my 5th baby, he is 6 months old. I wish I had known -truly known - about better nutrition then, or for that matter with all my pregnancies. Midwives play the scare card to try and get through to you. They really want the mother to have a good birth experience and hold to a healthy new baby to their breast. Sometimes they do not know how else to get through to us thick brained mamas. I mean that for me as well. She really does have your health and that of your baby in the right place. So -- think of it this way, what would you feed a newborn baby? That's what you should be eating.Hugs. You can do it.Jill M.

I don't know what to tell you. I'm having a similar problem with a couple of doctors right now concerning acid reflux and some new red sore that appeared on my toes. So far my doctors (gastrologist and dermatologist) have not been helpful. I'm also considering going for a second opinion. However since I started following some of the acid reflux "rules", like not eating past 7 pm, I have felt a lot better.

My OB also suggested that I cut out everything "white" as I had borderline gastric diabetes. I was worried about this, but my sister-in-law mentioned that everyone she knows had been given the same advice, too. The currywurst with mashed cauliflower sounds good and healthy. Have you tried pastry wheat flour (from Bob's Red Mill)? I like using it because it's not as heavy as the typical wheat flour. Also I use half wheat flour and half white with my baking. Now I mostly use 100% wheat. You could also try using some honey as sweetener in baking, etc, instead of sugar. Did I read that there is a Trader Joe's in your area? I hear so many great things about that store!

I'm sorry to hear about your pelvic pain, especially while walking, etc. I hope you feel better about this situation between you and your midwife soon. I too don't appreciate scare tactics.

Sorry you have to deal with that :-( I had a meltdown the week my childbirth teacher had us record, judgment free, everything we ate. It would really make me feel bad if my midwife told me those things.

My midwife always asks about my nutrition, but she doesn't say "STOP eating sugar!" That would so not work on me. If she told me that, sugar would be the only thing that ever crossed my mind and I'd feel awful whether or not I ate any. Instead, she tells me to try to control my sugar/junk cravings by eating plenty of protein. She said that many times, my body might tell me it needs sugar because it wants quick energy, but that if I eat protein the energy will last longer. Especially if I do cave and eat a bunch of sugar, I'm supposed to have some protein with it. This has helped me keep it somewhat under control, but honestly, my diet is nothing to brag about.

I'm feeling a lot of empathy for you right now. I totally understand how it feels to have your provider say those things and immediately start craving the foods you're "not supposed" to have.

It's not fair of her to play the dead baby card, for sure. I think if it was me (taking into consideration the difficulty in switching midwives, your preference for her low intervention rates, and your previous positive experiences with her) I'd probably try to stick it out with this midwife...but that's me.

If Sam is willing to cut out white carbs and sugar with you, I say it's worth a try for a week or so. You don't have to go along with the idea that they're "bad" foods to choose not to eat them for a short while, you know? You could think of it as an experiment! I really wish I had cut out gluten during my pregnancy (or even before) because I wonder if I would've felt better.

And about exercise, I know you swim sometimes, right? Water aerobics was the best movement activity for me during my pregnancy. It took away all the joint pain and helped ease the swelling in my legs and feet, too. It seems like if you're in pain, you should listen to your body, right?

First: anyone who pulls the dead baby card is an a$$hole and interested in manipulating their clients and not in educating them. If you feel confident, you could just lay out how you feel to the midwife and tell her you're no shrinking violet and she ought to start caring for clients and stop managing them. Or, get another midwife.

Second: so the "irresponsible" mama with the shoulder dystocia - what position was she in when she gave birth? On her ass? Back? Both are bad news for suspected large babies. If there is a shred of doubt about the suspected size of the baby's shoulders, stand or squat to deliver. You likely won't have any problems.

Third: from an evolutionary standpoint, the human body isn't designed to process grains and pulses well. Cutting them out of our diets confers huge health benefits and pretty effortless weight loss. I don't know about the South Beach Diet but I'd guess the reason you were hungry is because it recommends that along with cutting out "white stuff" it recommends low fat foods, too. If you have dietary concerns, check out Paleo eating. (Everyday Paleo, Mark's Daily Apple, etc) My family has been eating this way for a short time and are never hungry. Good saturated fats means we are satiated, we don't miss rice or pasta or bread and we feel far more energized.

I had a 9lb 12oz. baby last June and did not gain or lose weight with the pregnancy. So, you're right, weight gain has nothing to do with the size of the baby.I am a short person with a short husband and we are not BIG people weight wise.I didn't have GD, either.We do eat white flour/sugar.

I will caution you that if you have a female at your birth that you find irritating, intimidating, etc. it can affect your labor... so, make sure you really like this chick if you plan to keep her on board.

When I encounter providers that recommend things that I don't like I usually sleep on it and do a shit ton of research. Then I revisit the recommendation and determine whether or not it's something I think will be beneficial for me.

If I encounter providers that recommend things I don't believe in, OR subject me to needless editorializing I typically find a new provider. I don't see any reason to have someone who I'm not comfortable with on my team.

There has to be another way she could have made her point. My midwives stressed reducing my sugar intake and upping my protein intake. Their attitude was to eat kind of the way I would if I did have GD. And they presented it to me in a non-confrontational, conversational manner that made sense to me.

When I encounter providers that recommend things that I don't like I usually sleep on it and do a shit ton of research. Then I revisit the recommendation and determine whether or not it's something I think will be beneficial for me.

If I encounter providers that recommend things I don't believe in, OR subject me to needless editorializing I typically find a new provider. I don't see any reason to have someone who I'm not comfortable with on my team.

There has to be another way she could have made her point. My midwives stressed reducing my sugar intake and upping my protein intake. Their attitude was to eat kind of the way I would if I did have GD. And they presented it to me in a non-confrontational, conversational manner that made sense to me.

sorry to hear you're feeling so down about your latest midwife visit/experience. i have to agree with another response: i'm sure your midwife has your health and your baby's health in mind when she's telling you all this stuff. that being said, the sentiment can get (and possibly already is) lost if she's using scare tactics and ultimatums that you are clearly not having a positive response to.

if you didn't have GD with mikko and he was such a big baby, you'll likely be just fine with this one as well. though it's not at the last trimester yet and, even though you're not crazy about the advice you've been given or its manner of delivery by your midwife, you yourself seem to be a little concerned. my advice is to go ahead and have the GD test, and if/when it comes back all clear, maybe you could have a talk with your midwife about what's making you so uncomfortable during your visits. if she seems unresponsive to changing her approach, perhaps you may want to think about switching midwives after all. i know you really like her stance on interventions, etc, but in the end, it's going to be you doing what you, your body, and your baby need to do during labor and birth. if the person there to help you through it doesn't feel like she's on your side, it may not be as positive an experience for you and your family as you might have had if you'd done the hard work of meeting/interviewing new midwives.

i hope it all works out for the best.

i'll be TTC soon and i'm curious about what you and other posters/responders think of the GD test. pros/cons/etc. my mother had GD when she was pregnant with me, so i'm wondering if i should do it or not when the time comes.

You've likely seen it already, but I love this Peaceful Parenting article on GD: http://www.drmomma.org/2010/06/gestational-diabetes-emperor-has-no.html

I "failed" the first test last time, and got pretty worked up about it, but did fine on the second test. All along I questioned what I was doing to my body - fasting and then chugging a huge amount of artificially colored and flavored glucose to help me figure out whether I needed to eat consciously, when I was already eating consciously, just did not make sense. Personally, I intend to refuse the test if I'm fortunate enough to get pregnant again.

For what it's worth, I gained 30 some odd pounds in the first two trimesters, and almost nothing in the last - no dietary changes. Each pregnancy is different and I think it's ridiculous for anyone to imply that there is a right amount of weight to gain and a right time to gain it. Your body knew it was doing with your last pregnancy and it knows what it's doing now. Good on you for listening to it!

If GD is really a concern, just buy a glucometer (very cheap) and monitor yourself. Diabetes runs in my family and I wanted to monitor my blood sugar during my first pregnancy, even though I was healthy. I learned that I might have a problem with too much refined carbs and I changed the way I ate. I was 5'7", 120 lb prior to my first pregnancy so clearly not overweight and I gained about 35 lb. My baby was born at home at 8 lb 11 oz and healthy. I opted not to take the GD test or monitor my blood sugar with my second pregnancy, but I ate much, much less sugar and I knew intuitively that I was fine. That baby was 9 lb 7 oz, born at home, and healthy. I gained 35 lb, almost all of which was in the third trimester due to feeling nauseous earlier on and burning extra calories nursing a toddler.

I don't think that white flour and sugar are good for anybody, but I think that most people are okay with them in moderation.

Aside from her concerns with your weight/eating habits, how do you connect with her? I think the connection, her willingness to hear you out, listen to you, and respect your desires & needs for birth matter more than whether she feels compelled to recite her standard checklist during prenatal visits. This is not in any way reducing how it makes you feel to have the "dead baby" story recited, but more of a perspective thing. Because I know it's really tough to decide to switch care providers. And if in all other ways you feel she respects you, she may just have a lame bedside manner. I remember some of the midwives in the practice I went to with my 1st pregnancy were like this, others I totally lurved. But in all, they respected me, and wanted to help me acheive the birth *I* wanted.

As for the weight gain... I know you already know, you already said it - how much weight YOU gain isn't directly indicative of how much weight your BABY will gain. That's more determined by genetics.

I gained 40 lbs with my 1st baby, 46 with my 2nd baby. My 1st baby was just over 8 lbs, my 2nd baby was just under 7 lbs. My 1st pregnany, I had all sorts of cravings - chicken, fish, fast food, ice cream - and I'm a nearly life-long vegetarian. My 2nd pregnancy, I ate far more "healthy", no meat at all. Gained more myself, and baby was smaller. So go figure.

Of course, I advocate eating the most natural, unprocessed, and plant-rich diet you can - as often as you can, but eating cookies in pregnancy if you need them, won't hurt you. You do what you need to do to feel good. Feeling good in pregnancy, to me, IS A NEED.

As far as white flour/sugar... I stopped buying white flour altoghter a couple of years ago and instead only buy whole wheat white (King Arthur brand) - it tastes & looks & bakes MUCH the same as white pastry flour - I even use it in cookies. For sugar, I use brown or molassas whenever possible in baking, and maple syrup or honey in my coffee/tea.

As far as the junk food goes... there are some "healthier" alternatives - things like coconut milk "ice cream", dark chocolate instead of milk chocolate, etc. and when buying things in the grocery store, I try to go when NOT HUNGRY.

Your belly is beautiful, and you & your family is beautiful, and this pregnancy & your baby will be healthy. Keep your spirits up.

My first thought, before I even finished reading, was to change midwives. But I know that can be a major headache. If you do keep her, I suggest telling her you do not appreciate the scare tactics.

I suggest trying to work protein into everything you eat because the baby needs protein.

I'm all for the test because with Tyler I was borderline borderline (yes, I was almost borderline) GD. I had to watch my diet and I did check my blood sugar regularly. I flipped out in the middle of the grocery store at first. With Sasha, I was *officially* GD. Thankfully, my mother was a huge support. I support the test because without it I would have continued to eat lots of sugar (my sweet tooth is larger than my head!). That can literally make baby SICK when they're born. Ever had really low blood sugar? Imagine that for about 3 days. My GD counselor explained that to me as well as using a bunch of scare tactics that I also didn't appreciate. In fact, I had my blood sugar in check before I went to see her, then she had me so stressed that it went up! Stress can do that!

So once I was diagnosed, I was able to totally control it with diet. And what better motivator than a healthy baby, right? Sasha was born healthy, no blood sugar issues at all. And smaller than Tyler! (Tyler 8 lb 9oz, Sasha 7 lb 8oz) Yeah, I make big babies, too... just not compared to you! lol

I agree with a lot of the other commenters, that my first thought when you said she threw the dead baby card was, "Yikes, not too late for a new midwife."

I would personally take the advisement but not necessarily cut it out entirely, if it feels right. It sounds like she's got some paranoia going on, and I don't think it was at all right of her to shove that onto you.

That said, I've got zero midwife experience (next time, maybe). My OB was cool but extremely no-nonsense; I don't think we had much in the way of conversation until my third trimester, and I think it was just because I was her only patient not begging for an induction at 38 weeks. She actually never gave me any grief about my weight gain -- she had a number she didn't want me to go over, but even when I did in my third trimester she never mentioned it. I appreciated that.

That said, she did occasionally make fun of how I dressed. :( Once it was because I was wearing ragged flip flops in November (I loved those flip flops) and she said, "You don't want to look homeless, Ashley." The other was when I was wearing mismatched socks; I admitted that I picked my socks based on thickness rather than color, and she replied, "I'm pretty sure that these two socks have nothing in common, but you'r pregnant, so we'll give you a pass."

That said, the comments were months apart and otherwise she was rad. She even remembered me a year later when she came through the drive-thru at the drycleaners I worked at.

(Her nurse, on the other hand, may have hated men. My husband swore this, and I thought he was being paranoid -- but a friend of mine had the same OB, and she and I both realized that the nurse was only nice and talkative when we went to appointments sans husband.)

Regarding your midwife. Do you feel comfortable talking to her about "playing the death card?" If not, I would seriously consider switching. I've taken the stance that there are too many providers that aren't treating their patients like intelligent feeling beings, that the only way to make our voice be heard is to take our money somewhere else. Granted I'm not sure if you would be able to find a midwife this late in the game. I know when I was looking around here they filled up fast.

I am sorry you are in so much pain. That must be awful. I liked Amy's suggestion of swimming. I remember doing swimming with my daughter when pregnant and it was so nice to be lighter, but then when I got out of the water... ugh. :)

As far as the GD test. With my 1st I failed the 1st test, but passed the 2nd. When I discussed it with my midwife the 2nd time, she seemed to feel it was important, and I really respected her and I did it. However, the test is torturous. (You should take it in the morning and fast from 10pm the night before. This is how it is designed to be administered (the instructions are on the bottle), but lots of providers do not issue it this way, thus lots of false positives in the first one).

I think what is reasonable is to buy a glucometer (you can get a cheap one and strips at walmart for $25) eat a carb heavy meal, maybe not something you would eat every day, but something with just a bit more carbs than your normally eat (pasta with bread and maybe a cookie for dessert?) and then take you blood sugar levels 2 hrs after you eat. If the numbers are high then maybe do the official test, if not then you are good.

Looks like you've got lots of good advice here, but I'm never one to let an opportunity to throw in my two cents pass me by. :)

1. LOVE the picture. Kudos to you for posting it for the world to see the beauty of pregnancy.

2. I'm sorry your midwife is treating you disrespectfully. Many people have mentioned finding a new midwife, but I wanted to say that while my midwives (I saw a team of them) were pretty nice during visits, not overly fuzzy-wuzzy or anything, but the low/no-intervention birth I had with them was incredibly wonderful, I was so glad I had a midwife who I knew ahead of time would work to avoid interventions right along with me.

3. I remember crying several times about having to do the dang GB test. In the end, my husband and I decided to do it, but if I didn't "pass" we weren't going to do anything about it. We knew I exercised when I could (I too had awful hip pain that made walking or going upstairs to the bathroom extremely unbearable...unfortunately I still have it 4 months postpartum) and we also knew I was pretty good about what I ate- like you said, eating when I was hungry, but of course snacking a bit here and there. I was careful during my pregnancy to be healthy, while maintaining sanity, and I wasn't going to worry about it. It all worked out fine and it is quite likely that it will all work out just fine for you too.

3. I applaud you for delivering a 12 pound baby vaginally. You go, girl!!

As far as the midwife goes, I know how hard it is to consider switching care providers. I switched from an OB to a MW at 34 weeks pregnant. It was hard, but definitely the best decision I could've made for baby and I. I think it comes down to whether you feel respected and listened to and whether you feel like your MW is working for you to get the birth experience you want. I have a few close friends who have all used (and rave about) the same homebirth midwife, since we're relatively close geographically email me if you'd like her info.

With the diet, I think perhaps the message is meaningful, but it's lost with her delivery. I'm a firm believer of everything in moderation. I have mixed feelings about the routine GD screening. I failed the GTT with my daughter, but ended up having to add carbs back into my diet bc my levels were very low on the diet. I focused on healthier eating with my second pregnancy and had no problems with GD.

And, one more thing! You mentioned you can barely walk. Is it anything with your pelvis? I was in so much pain with my second and could hardly walk. My doc assured me that it was normal to be in a bit more pain the second time around. I was finally referred to an obstetric physical therapist and he gave me a few stretches and my pelvis realigned and I could walk pain free again.

I second the suggestion to tell your midwife that you've had enough on this topic. If you decide to keep her, that is. I'm thinking something like, "I know you are concerned about my health, and I assure that I am, too. I've heard the things that you've said and taken them into account, and now I would not like to talk about my weight and diet any further." Her response to something like that could tell you all you need to know about whether to stay with her.

Whether you decide to do the test is a complicated question, but I also second the possibility of checking yourself at home. Since I am not working with a medical professional with my pregnancy, I tested my own blood sugar at home. If I *were* seeing a professional, I'm sure that I would be diagnosed with GD. But through regular testing and adjusting my carbs, I am able to keep my blood sugar levels normal.

It *is* tough to be told what you can't eat, for sure! I'm up for helping you brainstorm yummy food options if you like. My diet used to be very high carb, but through experimentation (and LOTS of help from my friends) I've found all sorts of yummy things to eat and not feel *too* deprived.

Hang in there! Your belly looks beautiful, and you're almost there to having another big, beautiful baby! :-)

I'm very ambivalent about the GTT. I don't really believe in "GD", but I do know that there are plenty of possible underlying metabolic disorders that can get worse with pregnancy, and it can be good to know f your body's doing what it's supposed to.

I did the test with my first, mostly because I didn't think about not doing it. With my second, I hemmed and hawed and decided not to; I don't have metabolic issues (except maybe borderline hypoglycemia), and passed it the first time wth flying colors (and a 7lb baby). Also, I eat as healthily as I can afford to anyway. My MW had a borderline blood sugar done, and it was fine. This baby? 7lb 6.5oz.

If you do decide to do it, there are other methods of testing than the stupid glucola.

My advice? Get a new midwife. This is appalling. My midwife didn't even weigh me, let alone discuss my weight gain! She was completely uninterested in my weight as it's not really an indicator of anything. I gained 35 pounds and lost it all 2 weeks post-partum. I'm 5'4 and fairly petite, so 35 lbs was quite a bit of extra weight! But not a single utterance for the whole pregnancy. My midwifery clinic didn't even have a scale (at least not one that was visible).

I know GD is real and it poses real risks, but given Mikko's birth and weight, your own physique and your confidence and intuition that YOU know what you're doing, I'd ignore her or trade her in for someone with a little less attitude.

Since you expressed you were open to advice, I have some. First, if white sugar, flour etc. killed babies you'd have to explain to me why there are 6.5 billion of us, and a deplorable amount of people do not have access to varied diets nor medical care.

You wrote,

"I had a nearly 12-pound baby, with no dystocia, a mere hour and a half of pushing, a vaginal birth with minimal tearing, a pregnancy free of GD, a baby with no blood sugar problems, and a healthy outcome for all involved."

I cannot. Believe. This woman is giving you "dead baby" talk given that is your history (well, she shouldn't be doing it anyway but still). She is putting her orthorexic worldview above you as a client. It is causing you stress and misery. It is scaring your partner (tho' he should do his own research on this and no matter what, back you up).

So, I want to join the chorus & advise you get a new midwife. I'm not sure you need a narrow-minded orthorexic one. It's not your job to make her do her job better, but if you do leave her and you can manage it, letting her know exactly WHY might help her practice with more.

And please. Anecdotal "evidence" that baking= "too much" weight, and then kills babies? I had a friend who gained 70 POUNDS during her pregnancies. She did not develop GD, she had three fast and completely intervention-free homebirths with healthy babies Conflating weight with health - including fetal health - is incredibly myopic, likely harmfully so (I wonder if this midwife has any background or trusted expertise given how many women come from a history of eating disorders...).

As for transferring this late in the game, it might not be stressful at all. I transferred when I was nine months pregnant and it was the best birth/preggo decision I made.

Good luck. THANK you for writing this out. Pregnant women are shamed and policed in just about every way (and certain TYPES of pregnant woman more than others), regardless of best evidence. But telling a woman she can't BAKE or her baby will DIE is really chapping my ass.

Secondly, I'd like to chime in on the pelvic pain/swimming idea: Yes! Swim more! Also, a chiropractor with experience with prenatal adjustments would be a good idea. So might acupuncture, to help get things aligned.

I don't know about midwives' care and how easy it would be to switch, but I changed OBs at 20 weeks when my original one told me no birth plan or doula. You'll just have to decide which path you're more comfortable with.

Good luck, and hang in there... you'll be meeting your new, big, healthy baby before you know it!

At one point during my pregnancy with my son, my OB told me after refusing to take the gestational diabetes test that I could be killing my baby and might birth a stillborn. I then asked her where she got her license to practice. I stopped seeing her after that. I have no interest in being bullied, especially when pregnant. Perhaps your midwife is concerned for you but her use of scare tactics is unprofessional. I would approach her about your feelings about this.

a) Thank you for posting a picture w/ stretch marks. I have stretch marks from my first pregnancy and fear what subsequent pregnancies will do to me. I appreciate your fearlessness and hope I can emulate it.

b) If you want to know what I think of low carb diets, check out my recent post: http://notsosecretlifeofsbn.blogspot.com/2011/01/my-new-diet.html

c) You know yourself. You have educated yourself about birth. You have heard what your midwife has to say. You can make an informed decision about how to proceed that may or not be exactly what she advises.

Hugs! While I don't particularly agree with the way she passed on the information to you, I do think that she is only trying to help prevent the possibility of a big baby and the complications that might happen. So many maybe's and possibilities that might not even apply to you (especially since you've already had a large perfectly healthy baby). But unfortunately in the health care field, care providers can't just not pass on info to their patients. I think comments like the ones she made are hurtful because they often touch on an issue that might already be touchy with us...And in all honesty would it be so hard to switch from white flour to whole flour, refined sugar to less refined sugar? When you look at the big picture, it is true that those foods are not ideally "healthy" so maybe put a positive spin on this and make a change that in the long run will be beneficial for your whole family. As for the MW issue, if you don't want to totally find a new one, in the very least I think you should chat with her about the approach she took and that next time she wants to let you know information to do it in a more educational way, rather than a scare tactic way.

As tough as it might be maybe you could talk to your midwife about these concerns you have if you don't want to fire her. Let her know that playing the dead baby card is absolutely not acceptable for you and that you understand the risks. Her using scare tactics only serves to undermine your trust in her care. You can modify your diet some, but believe strongly that this is primarily a matter of genetics for you.

I'm so, so sorry you're dealing with this. It stinks. I have an amazing midwife now. She delivered my last two babies and will deliver the one I'm currently carrying even though we moved away and I have to drive over an hour for my appointments. Weight is not an issue for her. Nor does she force me to take the GD test. So I don't. And I'm so much better and happier because of it.

This is very different from my first pregnancy. I was also under the care of midwives, but they made my weight a huge issue to the point that I left almost every appointment in tears, my blood pressure sky rocketed, and I was an emotional wreck. I told them over and over I had suffered from an eating disorder and use to STARVE myself and that a little overindulgence was better than restriction for me, but they didn't listen. Then imagine my horror when I failed the glucose test and they diagnosed me with GD. I had a healthy BMI. I wasn't even 25 yet. I had no risk factors; yet, I had the diagnosis and the label and was put on a meal plan. I was forced to meet with a nutritionist who showed me what a "real" portion sizes looked like. I looked at her and said I knew every nutrition label and calorie content by heart of most of the food I ate because I was once was obsessed with counting calories. She said nothing. Then she continued showing me how to eat healthy as if I wasn't already eating healthy (I was a Bradley student and the time and strictly following the high-protein Brewer diet.)

My blood sugars NEVER were raised except during the glucose test. I argued about this, about my small frame reacting to these crazy levels of sugar, about my possible need to fatten a baby up. They just patted me on the arm and congratulated me for being so "good" and avoiding "bad" foods. I lost weight (about 7 pounds) in the third trimester. I became obsessed with my meal plan and being in control of my blood sugar numbers and my weight (hello, eating disorder friend!). And, yet, they kept telling me how great I was doing. I ended up gaining only 16 pounds. They still warned my baby might be big and gave me weekly NSTs during the end, which were anything but non-stressful. Long story sort of short, I was able to somehow achieve my dream of natural birth mainly because I had a very precipitous first-time labor and they did not believe that I could possibly be as far along as my contractions were telling me I was and mostly left me alone. I went from 1 cm to fully dilated in about 7 hours. I pushed for about 20 minutes. I gave birth to a pink, healthy girl. My blood sugar, which they only took once after labor, was low and they told me to eat something sweet (ha!). My "big" baby was under 7 pounds, although she was, in fact, my biggest baby so far.

All my pregnancies now have followed a similar weight gain pattern. For whatever reason I gain more weight in the beginning and then slow down. I do not have big babies. My last baby was 5 pounds 13 ounces. I eat well, but I don't obsess. My midwife now is so sensitive to my struggles and my fear of the scale. I wish you were given the same respect.

I'm sorry to make this all about me. This post just brought up a lot of anger from that first pregnancy and the way I was treated. If I had been left alone to trust my body and my instincts, I could have been saved a lot of angst.

I am not against pregnancy testing, and I do think that the GD test is important for some women because it actually detects some women who might have pre-diabetes, but I've also read that some smaller women's blood sugar naturally rises as a biological way to fatten up a baby. There's not one-size-fits all, but unfortunately modern medicine often treats the symptoms, not the individual and fails to see the big picture.

I wish you luck and will be praying for you and that beautiful miracle of yours.

First, I am sorry that your midwife is being so rude to you. If she is that concerned about your weight gain, she could have found a better way of telling you. I don't like scare tactics either.

Just because your first was a big baby does not mean this one will be. Sometimes we grow big babies no matter what we eat!It's true that cutting the white foods out will help with your weight gain, and the baby's at the end of your pregnancy.

You've done your research, you know there are many different positions to birth your baby. "big"(8lbs is considered big now) or small.

I had severe hip and pelvis pain from month 4 onward, in my second pregnancy. I gained 56 pounds. at about 45 pounds at 6 months, one of the 6 midwives at the clinic I worked with, said I had to lose 15 lbs by the time I deliver.

She didn't ask about the pain i was in, doing ANYTHING, much less excercising or walking. I prayed that she not be the midwife on call during my labor. Guess what - yep, she was. the labor and subsequent c section was much more influential to me than the weight I gained. In the same way that a woman's choice exists in abortion debates, a woman's choice also exists in her pregnancy weight gain. listen to your heart, follow it, and don't worry about it again. Not simple, but effective.

I am a Registered Dietitian who gained 50 pounds during my pregnancy. I followed all the advice I give to my clients, and no matter what I did to try to limit my gain, I was hungry. And my instinct tells me for most healthy pregnant moms, being hungry, tired and irritable is worse than a few pounds extra weight gain. As long as you're maximizing fresh, nutritious foods, with lots of fruits and vegetables, I don't see any reason to completely eliminate refined flour and sugar.

If unrealistic dietary advice was my only problem with my midwife, I'd probably just tell her what she wants to hear. But if she was really stressing me out with scare tactics like this, I'd switch. I think you have good reason to be irritated about it. Good luck with whatever you decide!

At the risk of creating a whole new post in the comments, I'm going to attempt to elucidate and respond. First of all, Sam's perspective: He thinks (and I agree) that our midwife said/says these edicts not maliciously but as part of her script. Telling me to cut out white flour and sugar and exercise more has been something she's said at every single visit, regardless of what I tell her I've been doing. I think it's the repetition, coupled with the prospective of the GD test and this newest horrible birth story, that is really wearing on me. She doesn't have a very good memory, as Sam will attest. She asks us the same basic information each time we visit (such as how big Mikko was and what sort of exercise I'm doing). It reminds me, and I don't mean this facetiously or as a diagnosis in any way, of visiting my grandma when she was in the early stages of Alzheimer's but we didn't know it yet. I think, in our midwife's case, it's that she sees so many people each day that she doesn't keep them all straight. So, even if I told her I didn't want to discuss weight, I'd fully expect that it would come up again the very next visit, as part of her general routine.

Sam also said his impression was that the birth story she told had happened recently and was fresh in her mind, and just came out since we were discussing GD (the way people link stories and keywords without really thinking about whether their stories are appropriate). I didn't get that impression, but I will admit I was distracted a lot of the visit by Mikko, who refused to come into the exam room with us but kept calling to me from the waiting room. (Who knows why!)

So, basically, Sam thinks it's just the way she is, and not directed specifically at me; that I'm just taking it that way. I could see that. I think it's very easy to be sensitive to any comments about weight, diet and exercise and take them as value judgments, whether that's intended or not — particularly when you've grown up in a culture that equates fatness with ill health, that condemns women in particular for appearances that don't conform with the established norms for beauty, and when you have a background (as I do) of unhealthily obsessive eating habits that you're trying to reform. It brings up a lot of baggage, is what I'm saying, whether she intends it to or not.

@Becky: We have tried the pastry wheat flour, and I think that's a good option for baking. This isn't directed at you in particular, but I wonder if everyone thinks we make all our food from scratch? I don't (and Sam, our main cook, doesn't) use flour very often in the first place. We've replaced any bread we do use with whole wheat varieties, but I get stumped/conflicted when I think about some of our favorite, healthy eat-out meals, particularly Asian places. I need to keep my iron levels up and have discovered that Asian food is great for this, as you can get a dish with meat but without calcium and with vitamin C (perfect for iron absorption). Plus, they're usually inexpensive and kid-friendly so a good place for one of us to take Mikko while the other person is working from home. Now I'm wondering — do I cut out my pho because it has rice noodles? But it has such a variety of delicious veggies in it. Do I cut out my mixed-veggie and chicken yakisoba because it has noodles and white rice? But Mikko will actually EAT the chicken and broccoli (glory be) and the noodles and rice, and again with the astounding amount of veggies for me. Some Asian places let you sub in brown rice for white, but not all the little places, and rice noodles are generally only in white. It just sets up these conundrums for me: Is it better to eat veggies and good sources of meat (and offer our picky preschooler something healthy he'll actually consume), or is it better to avoid white carbs at all costs?

@Amy @ Anktangle: Agreed, and your experiments with gluten have been inspiring, even though I don't seem to have any reactions myself.

What's interesting (frustrating) about exercise is these are the four things I'm trying: walking, swimming, water aerobics, and yoga/pilates DVDs from the library. The first three all hurt my pelvis and hips, but I'm trying to soldier on and ignore it. (Is that a good or really bad idea? I really couldn't say.) My favorite swim stroke — and I mean favorite as in, the only one I've done since junior high swim team — is the breaststroke (although, as my mom likes to say, I cheat and use my arms…). It uses a frog kick, though, which is TERRIBLE for my pelvis. Like, really, really bad. So I've been trying to train myself to do freestyle, but I can't breathe. I seriously am having the worst time breathing and then feel like such a dunce! So then I try doing breaststroke arms but with scissors kick, and it just feels weird. And then I do laps of just arms or just legs, or backstroke, or half-backstroke (just legs). But it's all so unsatisfying (le sigh). I'm hoping that I'll feel better about freestyle as I just practice it more.

And water aerobics is a terrific workout, but nearly all the motions involve large opening of the legs — again, terrible for my pelvis. And I'm such a classroom goody two-shoes that I canNOT convince myself to phone it in and not try to impress the teacher with how wide I can make my stance. (Silly me.) So, then, that kills, too.

I really like walking, because it's convenient (just throw on shoes and a coat! no finding my swimsuit and towel, dealing with Mikko's separation anxiety, driving to the pool, etc.), cheap, and clears my head. But I find I can't go very far without extreme discomfort. Plus, the weather's been so crummy, though I've tried not to be a weenie about that.

@mamaloo: I'm not sure of the mama's position, but I got the impression from the midwife's story that it was hands and knees. I doubt she'd have let her stay seated or on her back, since she really is a well-respected midwife when it comes to birthing at home. And I really wish I wasn't a shrinking violet, but sadly I am! But I like the IDEA of being as forceful as you say. I've tried paleo diets and raw diets and traditional foods diets and many other ones, and I just can't stick with the restrictions for the long term. It's cool that it's working for you, though.

@Issa: The testing-at-home option (as you and others have mentioned) is a valid one. I might try that. I don't think I'm at high risk for GD or diabetes in general, because I have no family history of it, despite most people in my family being overweight. I'd appreciate your tips for yummy food options!

@Kelly Hogaboom: Thank you. I'm glad to have someone chime in who understands that orthorexia is damaging in its own right (and it's something I'm trying to heal from), and can understand that even though I'm fat, it's not because I'm sitting around eating cookies all day. When the midwife said that the mother "admitted" to baking too much during her last trimester, I had to wonder how much of that admission was guilt-based. Because we (women, mothers) really are told, daily, that we're at fault (for whatever), and we tend to take it to heart.

@Sarah Beth: The fearlessness is something I'm attempting, and I'm glad everyone's responded positively to the picture! I also am wondering what new stretch marks I'll get this time around, but I think it's worth celebrating instead of feeling unworthy. I like your post!

@Kat: "And in all honesty would it be so hard to switch from white flour to whole flour, refined sugar to less refined sugar?" Speaking only for myself, yes. It is very, very hard. I've had rules like that running through my head for years, and I find I do eat more whole grains and less sugar when I don't police myself. This might not be true for everyone, but the very act of limiting my food choices makes me obsessive and irritable and starving, and more likely to "cheat" with stupid things rather than just eat the wholesome foods my body and my mouth want. (Like when you eat a bunch of no-cal, artificially sweetened Jell-O because you want something sweet rather than have a piece of fruit, because that has calories — it's a stupid tradeoff.) Again, this is just my experience, but I find it's a pretty common one among people who've been told (by society, family, friends, whomever) for years that they're not fitting into the ideal size and shape and that therefore they must be eating wrong or they wouldn't look like that. I started my first diet at age 9, and I gasp at that now — I look back at pictures of my skinny, prepubescent self and think, How on earth did I ever see myself as fat and unworthy even then? But I did. This isn't meant in its entirety as a response to your comment; it's just that, yes, truly, it is hard. It might not be hard for everyone, but it is for me. It's those messages that bring up all the other messages I've heard over the years, and that send the self-loathing coursing through me, when I really want to break free of that.

@Kate Wicker @ Momopoly: I was very interested to hear your stories, Kate, because you've been so open about your journeys through eating disorders. I'm astonished and appalled that a nutritionist wouldn't take your background seriously. That's exactly what I fear from this whole situation, and I'm sure it's not something the midwife intends — that I'll spiral into being obsessive, self-starving, over-exercising, number-checking — again. I've been there, and I don't want to go back. Especially not during pregnancy and then breastfeeding.

@Christina: So interesting to hear your perspective as a registered dietitian! I'm wondering if I should just "tell her what she wants to hear" and stop worrying that she's doubting me. I think that's what it comes down to — because she repeats the questions and advice every time I visit (see above for her short memory), I think I keep feeling like she thinks I'm doing poorly. Maybe if I can just be more confident that I am doing what is healthy, then I can shrug off the negative feelings.

All right, all this commenting helped me to process further. Thanks, everyone! :)

I am so sorry you are in the position of feeling like your midwife doesn't have your back. That sucks. And it would take a whole lot of effort to switch... Maybe you can just distance yourself a little knowing your own abilities in your own body.

That said, I am one of those people who recently had such digestive issues (even already gluten-free and dairy-free) that I have had to cut out ALL starch - grain, potatoes, etc. I'm going on the GAPS (Gut and Psychology Syndrome) diet, which is a challenge breastfeeding! But I know it's necessary for me. Part of the premise is that fat is really what we need, and letting ourselves have that rather than seeking the sweet will make us more satisfied.

Good luck! I think you probably know you don't need it, but I wish your midwife believed that!

I'm sorry that you were talked to like that by your midwife! I can really relate to your frustration and anger about being talked down to and possibly manipulated.I had my daughter in Japan, and I was about 10 pounds overweight when I got pregnant. So, in the eyes of Japanese doctors and midwives I was practically morbidly obese!I spent my entire pregnancy being told how fat I was, being talked down to and receiving horrible dietary advice. Meanwhile, I was eating healthy, working full-time teaching preschool, and walking about 45 minutes a day. I knew that I was in good health and taking care of myself. I ate sweets, but I also ate whole grains and lots of vegetables. I gained 19 pounds by the end of my pregnancy and had my 7.5 pound baby naturally. It is dis-empowering and unfair to treat mothers like ignorant children. Of course some mothers need more advice or support than others about diet and health, but you are obviously a well-informed woman, who has already has a healthy child! Good luck with your decision.

Awww Lauren, I totally didn't meant to dredge up all that from your past. And I certainly never assumed you only ate white flour and sugar! I apologize if my comment seemed insensitive, I didn't mean for it to be. You know how sometimes all you need to hear is "It's not so bad..." Well that's what I was aiming for, but it seems it probably wasn't the best way to say that! It's great that you know yourself so well that you know it would be hard to make a change...I would totally speak to your MW about this too, if you feel comfortable of course. Ideally, you want to be taken care of by someone who understands how you work and the best way to approach stuff with you. Hugs!

@Megan: "It is dis-empowering and unfair to treat mothers like ignorant children." Yes! Thank you. I remember feeling that same disempowerment in the hospital during and after Mikko's birth — as if I had done no research and put no thought into my choices, when I knew I had.

@Kat: I'm sorry, Kat. I definitely didn't mean for it all to come out as if at you. I've been brooding on the subject all day, obviously, and I apparently just needed an opening for it all to spill! (Again.) I actually do agree that switching to whole grains & less sugar isn't hard on face value — for instance, I don't really care whether I have whole wheat bread or white and have long preferred the taste of the whole wheat — then again, I like the taste of potato rolls, too, and those are out. I never put sugar in my tea or drink sugary drinks, so there's nothing to substitute there. It's more just the overarching, long-term issues I have with restriction and making things "forbidden." But sorry if you felt the brunt of it!

Hey Lauren. I'm going through a similar thing on the other side of the world (in New Zealand). My first baby was large (10lb 12oz - no indications of GD on post natal testing) and I'm 29weeks pregnant with #2. My midwives (esp my current one - have temporarily moved cities so seeing a subsitute for a month or so) are jumping up and down about this baby probably being big also. Despite having NO clinical indication for it. You might be interested to know my glucose results as your situation sounds similar to mine. I declined to have them in my first pregnancy but this time, due to pressure from the Midwives from #1 being so big I have recently had a fasting 2hr glucose test. The results came back completely normal. Not even close to being borderline high. Yet still, the midwife giving me the results over the phone told me I was still probably at risk and to stop eating refined sugars. So so annoying - I mean - what is she basing this on?? ALL my tests so far, and past experience have indicated that my body IS capable of growing and birthing a healthy large baby. Same with you. I have a good friend who is a midwife - when I told her my results you'll be pleased to hear she told me to go celebrate by eating some chocolate (I did!)

My response the few times my otherwise wonderful midwife started trying to use scare tactics about diet and exercise (Never eat cereal! It's as bad as eating pure sugar!) was to tell her my viewpoint on food and movement and to gently remind her that I would start lying to her about what I was doing if she kept pushing this. I have with other health care professionals, mostly dentists, told them flat out that if they didn't stop trying to scare me into "good" behavior, they would lose my business, but that is so much harder with a midwife that you otherwise like.

As a 29 week preggo with boderline sugar issues last pregnancy, I saw a nutritionist at the begining of this one for preemptive tips on how to feel better this pregnancy and avoid sugar issues this go round. Knock wood so far so good, have gained less weight and feel pretty darn good. The key, is not cutting everything out, but balance and combining your protien and carbs in a way so as to burn the carbs you do eat slowly. I was given the guideline of 15 grams of carbs and 15 grams of protien for snacks - and roughly 30 grams of carbs, 30 grams of protein for meals. 3 meals a day, 2 snacks. Approximately 1800 - 2000 calories a day. Moderate exercise if possible in the evening to help regulate sugar though the night. No sugar bombs like juice :) A standard fare for me: Western brand english muffin (lower carb) with peanut butter for breakfast with lowfat milk. Cheesestick and fruit for snack. Kashi brand micro meal for lunch (at work - read the labels, if you are short on protien pack some nuts), lean meat, like turkey on toast for snack, and then dinner last night was a low carb noodle with tomato/turkey sauce, brocolie and yogurt for dessert. Not hungry. Easy peasy. Do I miss sweets? Yes, sometimes, but then I eat them (like one or two the five year old's valentine's chocolates) and note them, and consume some protein with them. White flour, wheat flour, sugar, eh. I've started tracking my intake at myfitnesspal.com - as it tracks carbs and protein as well. Makes it simple. Good luck! Only a few more months to go.

I am one of the healthiest eaters I know. I eat very little white flour. I do enjoy what I eat and don't deprive myself. I gained 60 pounds during my pregnacy. I ate healthy food, didn't over eat, walked an hour a day (all nine months) and practiced yoga three times a week. I STILL gained 60 pounds. My baby was 10+ pounds at birth, was thriving then and is thriving now. I had an unmedicated birth and he was born sunny side up. I think my baby needed that weight. I don't know why, but he did. He's ten months old now, and I still have 15 pounds to lose to get back to my pre-pregnancy weight. I'm not that worried about it. For me, the important thing is do what is healthy and try not to worry about the rest. Best of luck to you and your family!

My apoligies if I'm being a buttinsky now, but if my midwife had such a terrible memory I think I'd ask her why she doesn't write this stuff down. Shouldn't it be standard practice that she consults your chart to refresh her memory before seeing you? My midwife gave me a card where she would record all my numbers at each visit so I could have a copy as well as her.

I'm sure she has all the technical skills of a midwife, but it sounds like she needs major work on her bedside manner.

I have Type 2 diabetes and as such I am very aware of the risks of having untreated diabetes (including GD) on a baby. I would never ever recommend skipping your test for GD. If you do in fact have it, you would want to know.

As for the weight gain, since I am diabetic already I was taking insulin throughout my pregnancies and suffered badly from hypoglycemic episodes - confusion/sweating/unable to speak. I was under orders from the dietitian to eat full meals at 2am to control these episodes. Obviously eating meals throughout the day and night meant *I* gained a lot. Over 70 lbs with both pregnancies. However, my babies were in the 8lb range. Mother's weight does not necessarily translate to baby weight.

I also suffered from symphosis pubis disfunction which caused terrible pain in the pelvis. Walking became excruciating and I got to the point where exercise wasn't possible. Neither was even normal walking from my car to the hospital. I do not recommend pushing through the pain, if you are feeling something similar. My youngest is almost 2.5 and I still feel pain in my pelvis during exercise. DO NOT push it. Ongoing pelvis pain is not something you want. |Trust me.

Try to eat sensibly sure. You want to aim for 30g carb breakfast, 15g snack, 45g lunch, 15g snack, 45g dinner with protein at every meal. Your body doesn't really care if that carb is from white flour or white sugar. A carb is a carb and will always turn into sugar. However, a whole grain carb or one with a lot of fiber will take longer to turn to sugar. You can still eat a donut for breakfast as long as it isn't over 30g carb, but you will be hungrier faster with the donut than you would be with whole grain toast.

It sounds like everyone has covered it, but I just wanted to tell you that I think moderation is the key when it comes to food. No one should tell you to cut out anything entirely. "Diets' are famous for this and it is exactly why they fail. Eating a healthy variety of real foods, mostly plants, ultimately keeping it simple is your best bet for health and happiness. Seriously. Eat the cookies and chips and other comfort foods that are considered "bad" but eat more of the good stuff. That's all I would suggest. :)

Lauren, I'm so glad you wrote this post to work through all of your feelings on this, and I'm also glad you're getting so much helpful feedback! Your bullet points are exactly what I think I would be thinking if in your shoes. I saw your follow up comment about maybe the mw just has a bad memory or needs to keep asking the same things b/c she is so busy... Part of the reason I used mw care in my pregnancy was because I wanted my pregnancy to be treated as what it was - a personal, special, miraculous experience - and I wonder if the lack of attention to the little details conflicts in any way with what you are looking for in a mw experience.

Um, well, she's not asking you to do anything potentially dangerous, even if it is against your philosophy, so that's one thing to consider. I do hate scare tactics, though. My perinatologist used it with me, a lot, and I would have gone and found a different doctor only she was considered the most expert on my condition. I'm still not confident with her decision to induce me at 39 weeks, though. But induction is potentially risky, improving your diet isn't.

I feel ya on the diet restriction, though. I was told to go off sugar for a month, and then I just craved it even more. That's why I normally try to improve my diet by adding more beneficial foods into it, rather than focusing on taking things out.

You can still find another midwife, you have time. Maybe shop around a little before giving her the boot. Good luck!

I've gained more this time too, though my midwife hasn't said anything... And I don't think she cares too much because it's not that much more. But the thing I'm wondering is, I wonder if our bodies know they'll ve nursing two once we give birth. Like since we're nursing through pregnancy. You said you lost all your weight right away? Maybe your body is stocking up this time to feed both Mikko and the new baby. I know how you feel though. My midwives last time mentioned weight and it made me really self conscious. Why should a pregnant woman feel restricted? I mean aren't we made feeling that way enough?I don't eat much sugar or grains but only in the last month or so as I'm able to eat like I normally do. But no one can tell you what to eat, it's hard enough trying to find something that even sounds good half the time. I wish you luck in whatever you decide. Just trust your instinct. :)

I am late to this, but in case you want more advice than you've gotten, here goes.

First, on the white flour/sugar thing, I actually do believe that white sugars and flours in excess could be harmful. We use whole wheat flour and demerera sugar mostly. So far, there has been very little that has had a noticeable taste difference. I do add vital wheat gluten to loaves of bread, but otherwise even my husband hasn't noticed any huge difference. I even made sugar cookies with whole grain flour. I still wouldn't call them healthy but at least they're slightly less processed. ;)

That's sort of beside the point though, really. To answer your question, I had a GP who obviously felt much differently than me about health (she constantly made negative comments about the fact we had a homebirth with a midwife, and I didn't like the way she treated my newborn daughter at all), and I fired her. I lucked out and found a fantastic GP after that and my midwives have both been great. I know not everyone is so lucky.

Personally though, there are times that doctors are necessary, and I want to know I can trust my doctor (or in your case, midwife) if something comes up. With my midwives, if they had said that maybe we should consider transferring because of a certain reason, I would have still asked more questions and thought things through, but I would value their opinion and take it into account. I would hate to feel like I should be second guessing everything they say.

Also, in my opinion, one of a midwife's jobs is to be a positive and supportive partner. My second midwife used to say things like "You've done this once, you're going to spit this baby out this time!" or "You will have a fabulous birth!". Of course, there's a fine line between being positive and supportive and making false promises, but if she had been only concentrating on the fact that my last baby was posterior and it could be even worse this time, that would have been disheartening. Instead, she took that into account but helped find ways to prevent it and pointed out that obviously I'd done it once, I could do it again.

Anyway, this is long-winded, but birth is such a private and personal thing and I absolutely think you should be comfortable with your midwife.

Sorry, I wasn't long-winded enough and meant to add two more things: First, now that she's done this, if she were to bring up any potential problems from now on (and especially during birth), would you trust her? Or would you constantly be second guessing her? What if she plays the "dead baby" card while you're in labour?

Second, about the GD testing. I declined it both times, though I have 0 risk factors whereas it sounds like you may have a couple. I have read though that for a woman who eats fairly well, gets a reasonable amount of exercise, and generally takes care of herself, you're doing a big part already towards preventing complications from GD anyway. I found a study (peer-reviewed) that found in studying 1200 women, 600-ish of whom were not tested for GD and 600-ish of whom were, that there were no significant differences in the outcome of their births. I have read other studies or more anecdotal reports about how GD is very easy to get false positives, and getting a positive can suddenly turn you into a high risk pregnancy for no reason, even if you retake it and test negative. I know there is a small number of women who end up having GD with no symptoms, but in general from the reading I did, you would notice something is wrong (whether from urine samples, how you feel in general, etc).

I'm way late to this, but I thought I would offer my perspective as someone who has had GD during all of my pregnancies. In my first, I barely passed the 3-hour GTT and because I passed, I took it as a license to eat whatever I wanted. When I started feeling my heart racing and short of breath after almost every meal, I did wonder what was going on, but I kept on baking and eating desserts and drinking chocolate milk, etc. I know now that I had GD and should have been controlling my diet. My son was born perfectly healthy and 7 lbs. 6 oz. (but based on genetic factors I expected an even smaller babe).

Fast forward to second pregnancy, when the GTT was on the horizon I got a glucometer and started testing at home because I KNEW I would not pass this time. Lo and behold, it was clear from my results that my body's ability to process carbohydrates was compromised by pregnancy, and I needed to change my diet. Did I hate it and resent it sometimes? Yes. But I did it anyway because I knew it was healthier for both me and the baby to make these sacrifices for a few months than to risk what had happened with my first -- blood pressure went up at the end and I had to birth in the hospital instead of the birth center. (I later found out that uncontrolled GD is a risk factor for PIH and preeclampsia). Because I kept my blood sugar in check, I did gain less weight (25 lbs v. 35lbs) and my blood pressure stayed excellent right up to the end.

Not every woman who craves sugar or gains more weight than doctors/midwives prefer during pregnancy has GD of course. But it is really important to find out whether you are one of those people whose capacity to process carbs is compromised by pregnancy. While I adamantly disagree with the way that GD moms are subjected to unnecessary interventions and viewed as high-risk by some providers, on the flip side I see a great deal of denial in the NCB community about the existence of GD. I know from personal experience that it is absolutely real. I wanted to deny it too because I didn't want to be "labeled" ... but every time my heart raced an hour after eating too many carbs, it proved to me again that I needed to put my desire to eat cookies aside until after the birth for both our sakes.

You don't necessarily have to do the GTT to figure out whether you are processing carbs normally -- I second others' recommendations to get a glucometer and test yourself at home. That way you will know how your body is responding to what you normally eat. Every provider I have spoken to about this, including OBs, has been open to using this as an alternative to the GTT, so I haven't had that nasty glucola crap since my first pregnancy.

One important thing to keep in mind about "white" foods and refined sugars is that humans did not have access to those types of foods (with the exception of white potatoes) for most of our history. Evolutionarily, we are not really designed to process a great deal of simple carbohydrates, and that's why we have such a high rate of type 2 diabetes now. We eat them because they are delicious, but are they good for us? No (I am sorry to say).

Does that mean you have to cut anything completely out? No, it just means eating smaller portions at more spread-out times. So, you can have (a reasonable portion of) rice OR bread with your meal, but not both. I try to fill half my plate with vegetables, 1/4 protein, and 1/4 or less carb, and that tends to work pretty well. I still eat some rice, pasta, and bread, but much less than I do when not pregnant. I actually like to save my allotted carbs for dessert -- a few pieces of dark chocolate usually. (Rice doesn't taste good enough to me to waste the carbs on!) Occasionally I will still have a cookie or something as a stand-alone snack. Eating smaller portions more often is helpful in keeping blood sugar stable.

Re your midwife ... she probably could have presented the information she was trying to convey in a more constructive manner. OTOH, I can sympathize with health-care providers on the subject of nutrition. Most patients are not going to change their eating habits unless they are in imminent danger, and maybe not even then. My dad is a 30-year noncompliant type 2 diabetic and it drives me absolutely batshit crazy to watch him eating candy and cookies all the time and never checking his blood sugar. He's still alive and has all his limbs, but I know he's doing organ damage to himself every day and it's frustrating. Not to compare your situation to his, but just to say that if I was a health-care provider and was faced with that kind of recalcitrance all the time, I don't know how I would handle it. Shoulder dystocia is a scary, scary situation for a provider who delivers babies, and I think it's especially hard for them because they can't really predict it but they desperately want to. So they end up erring too far on the side of caution and it's frustrating to those of us whose babies are fine, but maybe if we were in their shoes we would feel the same way, kwim?

I totally understand that talk of restricting brings up emotional issues for you and I agree that being shamed about your weight gain was not a good way for your midwife to reach out on the subject of nutrition. On the other hand, no need to throw the baby out with the bathwater (so to speak). Cutting back on less-healthy foods is never a bad thing for anyone, pregnant or not, GD or not, so you could take this as an opportunity to try to make some changes in your eating habits. That's how I tried to look at it and I made some permanent changes in how I usually eat because I know I am at high risk of developing type 2 in the future ... though I have not eliminated anything entirely and still have cake at birthdays and holidays, bake Christmas cookies, eat chocolate, drink wine, etc. It has made me more conscious of what I feed my kids, too. Overall I am glad that I had/have GD -- it was the kick in the pants I needed to make some positive changes.

Sorry for a long and rambly comment (and I'm a first-time commenter too, longtime lurker). You look great and best of luck in future interactions with your midwife!

My midwife harped on me the entire pregnancy. Some weeks I gained hardly anything and then others I seemed to make up for it. All told, I think I gained 35-40 lbs, a good 10 lbs of that in the last 2-3 weeks. She was hitting the roof at that point (I might add that I went a full 42 weeks and there was NO EFFING WAY I was going to increase my activity at that point).

In the end, I dropped all my pregnancy weight within 2-3 months and even lost an extra 15 lbs after the fact (all just from breastfeeding and eating when I was hungry).

The thing about scare-tactics is that they're as unhelpful as spanking; they're basically the equivalent to an adult. I'm so sorry that you're having to manage your midwife as well as your pregnancy, but trust yourself, your body, eat right, be conscious and your body really will know what's to do.

Personally, I would probably attempt to switch midwives. My OB lectured me throughout my entire third trimester about my weight (I, too, only gained 33 lbs the entire pregnancy which is considered in the "normal" range for an "average-sized" woman.) He did NOT use the Dead Baby argument. He, instead, went for the Ruined Vagina argument. Which led me to believe that 1. He didn't know me very well at all. and 2. He was a Jackass (pardon my French) for effectively telling a pregnant woman that she was fat, it was her own fault, and her body and future would be ruined because of it. I was incredibly angry with him, but loved the other OB in the practice and was a tad naive as a first-time-mom thinking that no other OB would be any different. (My son was not a big baby. He was born at 8lbs 2oz. and I DID have GD...which did not affect his blood sugars at all.)

I also don't agree with the standard way of testing for GD. No one in their right mind floods their body with sugar and then tests their blood to find out if they're diabetic. I requested to simply test my fasting blood sugar and my blood sugar after a meal for a week next time around and my doctor agreed that that was perfectly acceptable. Once you're diagnosed with GD, you'd be testing normally anyway and your sugars would be wacked out. Why bother putting your body through the silliness of a standard GD test if you don't have to?

Anywho. That's just my two cents. The important thing is that you feel comfortable and involved with the treatment you're receiving.

So sorry I don't have time to read up on the comments to make sure I'm not redundant ;) IMO the GD test is all risk no benefit - leads to fear and unnecessary intervention when really there's no "condition" to worry about. http://www.ivillage.com/gestational-diabetes-3/6-a-129187

On the midwife...If she's using scare tactics I *promise* you she will not be as hands-off as you are hoping and expecting. Using fear as a motivator simply isn't consistent with a philosophy that would also provide a safe, supportive, non-interventive environment for normal birth. Personally I'd ditch her because the very presence of a person such as that in the room can greatly influence (even if not consciously) your birthing self. Also her lack of attention to the evidence about GD, big baby, etc is a red flag that she's not keeping up with the research. But of course, *first and foremost* you must listen to your instinct (which your post seems to indicate leads toward moving on ;D).

FWIW, sugar is not food :) And this comes from a mama with a terrible sweet tooth. I do it, but with the full knowledge that it is literally damaging my body every. single. time. White flour isn't so dramatic, but if you want to know more about sugar, watch here: http://www.youtube.com/watch?v=dBnniua6-oM

Good luck with all the decisions and lots of positive vibes coming from this direction whatever you decide <3

Lauren, I realize you've had your baby - and I haven't read all of the comments - so much of this may be a moot point...

It is hard to determine what foods lead to weight gain in what mommas. I feel you on not responding well to scare tactics.

As mothers we are offered the opportunity time and time again to tune into ourselves and our innate wisdom - or connection to it - to make such evaluations and decisions. Which is likely what you have done since writing this.

With all of the experience of food sensitivities and scares in our family I find that a whole foods in as close to their natural state as possible approach is the simplest... but it doesn't always feel simple coming to that. The stores just have too many luring items!

i'd try addressing your concerns with her--you may find your common ground yet without the hassle of starting over. if that doesn't work, i'd change providers. you want somewhere there who is gracious, listens, and doesn't play games.

when pregnant, i ate whatever i could keep down without vomiting (including generous amounts of chicken nuggets and chocolate milk), and i think we should all have a little grace with ourselves. i limit--but eat--both now, but i don't kid myself either--there is nothing redemptive (except maybe psychologically) and certainly nothing natural or nourishing in either of those "foods."

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Riding the rails with my husband, Crackerdog Sam, and our hobo kids, Mikko Lint Picker (born June 2007), Alrik Irontrousers (born May 2011), and one on the way (coming October 2014). Trying every day to parent intentionally and with grace.